Jail ill-equipped to manage inmates' mental health

Despite recent efforts to improve police encounters with people who have mental illness and direct them to care facilities, Columbia County Sheriff Jeff Dickerson said too many mentally ill people are still landing behind bars — where access to mental health services is spotty and the potential for liability is high.

"They're not taken into custody for being mentally unstable. They're taken into custody for committing a crime," Dickerson said.

It's a statewide problem, Dickerson said, pointing to recent litigation resulting in large payouts by Lane and Lincoln counties for mistreatment and neglect of mentally ill inmates. Dickerson said he even envisioned a time when he or other Oregon sheriffs would not take some mentally ill people to jail in the context of committing a crime.

"Jails, or corrections, are caught holding the bag on these guys. It's a you're-damned-if-you-do-damned-if-you-don't situation. It's getting scary for us," he said. "I don't want to be the sheriff who does this, but there are some who are saying we start flagging people who could get them in serious trouble."

State funds available through the Columbia County Medicaid provider for mental and behavioral health services, called Greater Oregon Behavioral Health Inc., could provide some relief, however, as could a faith-based solution Dickerson is independently pursuing.

Through dollars collated by GOBHI, Columbia Community Mental Health, the county's mental and behavioral health agency, has earmarked funding for a 40-hour-per-week mental health counselor at the jail for at least a year, said Roland Migchielsen, the agency's executive director.

(See "Editor's note" at end of story regarding Migchielsen's position at CCMH.)

"This is something we have been asking for for years," Dickerson stated in an email to the Spotlight of the full-time jail counselor funding. "It looks like it will be taking shape in the coming months, and I couldn't be happier about that."

"As far as I'm concerned, we can start tomorrow," Migchielsen said, adding that the position has been advertised. "I decided to use that money for mental health services in the jail because there are high needs, and there are often too many hurdles if we do it the regular way."

Among the hurdles, Medicaid via the Oregon Health Plan is not available to inmates, Migchielsen pointed out, creating a funding roadblock for care. Instead, mental health services in the jail are provided by a county-contracted medical services provider, which now supplies a 16-hour per week mental health counselor in the jail and "telepsyche" phone counseling services at the county's expense.

Migchielsen said it's not only a lack of services contributing to the problem of mental health care in the jail.

"Sometimes it's how a person presents and they're not interested, and sometimes there are gaming-the-system scenarios," he said. The jail and CCMH also cannot legally force someone to receive mental health services.

The GOBHI allocation precedes a grand jury report released this week by Columbia County District Attorney Jeff Auxier that identifies shortcomings in the jail following use of a canine last August to subdue an uncooperative inmate who was reported to have a history of behavioral health issues. Included in the report's recommendations is that the jail should have a qualified mental health practitioner available at all times to work with inmates in crisis to de-escalate situations prior to any use of force.

Migchielsen said he anticipates the presence of a full-time jail counselor, at the state's expense of around $90,000, will lead to an increase in the number of mentally ill inmates who seek help.

"Once you have a little bit more time to do some motivation actions or help someone with some needs that they have on that day, then you start to build a relationship and you have a little bit more chance someone gets interested," he said.

In January, Dickerson convened a group of local church leaders for what he called a "mental health first aid class" to assess how Columbia County's faith community could help provide mental health services to jail inmates. He and other staff, including the jail chaplain, also traveled to Omaha, Nebraska, to explore a faith-based program he discovered online that could be tailored to the Columbia County Jail's needs.

"I'm a Christian and my faith informs me there are other options than the government. For some. Not for everybody," Dickerson says. "There are some who have leanings toward a faith-based answer, and we certainly run into some of them in jail. But we don't have a faith-based solution."

Any added mental health services at the jail, faith-based or otherwise, would be a boon for Dickerson in light of a spike in mental illness. The National Alliance on Mental Illness notes that as many as 1 in 5 adults in the U.S. will suffer a mental illness over a given year.

Dickerson said jail incarceration often leads to the deterioration of conditions for those who suffer from mental health problems, adding that mental wellness is a low factor among the jail's priorities of safety and security.

"Getting better is not one of those things," he said.

Editor's note: Following reporting on this story, the CCCMH board of directors on Tuesday, Feb. 27, announced it was cutting ties with Migchielsen as the nonprofit agency's executive director. In a follow up discussion with Dickerson, he said the CCMH board's personnel decision adds uncertainty to the status of the full-time in-jail mental health counselor position.